- Joined
- Jan 5, 2021
Ill put the first paragraph here and the rest under spoiler
To the Editor: A 37-year-old woman with a history of IV heroin use crushed a whole black widow spider, mixed it in 10 mL of distilled water, and injected the mixture intravenously.
To the Editor: A 37-year-old woman with a history of IV heroin use crushed a whole black widow spider, mixed it in 10 mL of distilled water, and injected the mixture intravenously.
One hour later she presented to the emergency department complaining of severe, generalized muscle pain and cramping, mainly affecting her abdomen, thighs, and back, and of a headache and anxiety. She stated that she had given herself the injection with the intent of getting a high, and she denied suicidal ideation. Blood pressure was 188/108 mm Hg, pulse 188, respirations 28, and temperature 99.5°F. On initial physical examination the patient demonstrated anxiety, with mild, generalized diaphoresis. Her heart sounds were tachycardic, the lungs were clear, and the abdomen was diffusely tender. Initial laboratory findings were normal, except for a WBC count of 15.5×109/L and increased levels of liver function enzymes (lactic dehydrogenase, 764 U/L, aspartate aminotransferase, 68 U/L, alkaline phosphatase, 188 U/L, total bilirubin, 1.3 mg/dL). The patient was given IV calcium gluconate, 1 g in a 10% solution, with minimal transient improvement. She subsequently required IV morphine, approximately 10 mg/hour, which relieved her pain. The patient had a history of asthma and became dyspneic a few hours after presentation. Lung auscultation revealed diffuse wheezing. After three treatments with full-strength albuterol, the patient continued to experience dyspnea and wheezing. Methylprednisolone given, and the patient was admitted to the ICU. The next day, in the ICU, the patient became intermittently dyspneic and continued to require frequent nebulized breathing treatments. Her muscle cramping was well controlled with morphine and lorazepam. Calcium was not used in the ICU. Antivenin was not used during the patient's stay because of the potential for anaphylaxis, which we believed might have compounded the patient's already compromised respiratory status. By day 2, the patient was free of pain. Her lungs were clear, and her respiratory status had improved to baseline. She was transferred to a basic ward and discharged for psychiatric evaluation the next day. She was sent home with instructions to take oral steroids and her usual asthma regimen. Findings on follow-up 1 month later were normal. Bronchial smooth muscle contraction in our patient may have resulted from a direct toxic effect of the large amount of black widow spider venom injected. In addition to causing generalized skeletal muscle cramping, Latrodectus venom is thought to cause smooth muscle contraction.1 Another possibility is that one of the various proteins contained in a whole spider, injected intravenously, precipitated an allergic reaction in our patient. Allergy to venom itself has been reported in crotalids, but we are aware of no reports of allergy to spider venom.2 In addition, venom or other proteins may have served as an extrinsic allergen, exaerbating asthma in a known asthmatic.
